Action Points

Note that this statement from the Institute of Medicine highlights the importance of bystander-initiated CPR to improve out-of-hospital cardiac arrest survival.

Be aware that survival rates of cardiac arrests that occur in the hospital are substantially higher than those that occur outside of the hospital setting.

Close to 400,000 cardiac arrests occur outside of hospitals each year in the U.S., and only about one in 20 people who suffer cardiac arrest events survive, according to a report from the Institute of Medicine.

Educating and training the public on how to recognize and respond to cardiac arrest with the goal of increasing bystander CPR was among the strategies outlined in the report to increase survival.

Robert Graham, MD, of George Washington University, Washington, D.C., who chaired the IOM committee that wrote the report, said even though bystander CPR and automatic external defibrillator (AED) training could save many lives, each year less than 3% of the U.S. population receives this training.

He added that decreasing the time between cardiac arrest onset and the first chest compression is critical to improving cardiac arrest outcomes.

"The necessary first response is not complicated. It is just compression," Graham told MedPage Today. "Calling 911 immediately and starting CPR could make a big difference."

1 in 4 Hospitalized Patients Survive

Although out-of-hospital cardiac arrest (OHCA) survival remains dismally low, in-hospital survival rates were somewhat better. The report found that roughly one in four (24%) of the 200,000 patients who suffer cardiac arrests while hospitalized each year in the U.S. survive the event.

The report also highlighted wide disparities in cardiac arrest outcomes by location, citing one study finding OHCA survival variations of from 7.7% to 39.9% across 10 sites in North America.

This suggests that efforts to improve cardiac arrest responses at the community level could have a big impact on outcomes, said pediatrician and critical care specialist Monica Kleinman, MD, of Boston Children's Hospital. Kleinman is a spokesperson for the American Heart Association.

"There are pockets of excellence in the U.S. where the tiered approach of public education, access to defibrillation, EMS system improvements, and hospital post-resuscitation care is making a big difference," Kleinman told MedPage Today.

The IOM committee identified seven strategies for improving cardiac arrest survival and improving the quality of life of patients who do survive. They included:

Expanding research in cardiac arrest resuscitation and promoting innovative technologies and treatments

Creating a national cardiac arrest collaborative "to unify the field and identify common goals"

Dispatcher-Assisted Bystander CPR Is Key

Kleinman said one of the most important recommendations involves EMS dispatcher training to assist 911 callers in performing CPR before EMS responders reach the scene.

"This has been an intense area of focus, and in communities where it has been implemented rates of bystander CPR have increased dramatically," she said.

The AHA's 'Two Steps to Staying Alive' public education campaign recommends calling 911 immediately when an adult or teen suddenly collapses with little evidence of pulse or breathing, and starting hands-only CPR to the beat of the BeeGees' song 'Stayin' Alive,' noting that the song has the right beat for CPR.

The IOM report found that eight out of 10 out-of-hospital cardiac arrests occur in the home, and just under half (46%) are witnessed by another person.

If the AHA recommendations were followed for every witnessed cardiac arrest, far more patients would survive, Kleinman said.

"It may not be realistic to expect that everyone in the U.S. will have formal CPR training," she said. "But the next best thing is to make sure everyone knows these simple steps. Having a system of emergency response in place to instruct people who call 911 is also critical."

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